Homocysteine

Many disorders are associated with increased levels of total homocysteine. In this section, the basic biochemistry, clinical significance, and measurement of total homocysteine (tHcy) are summarized. 

Numerous studies have suggested an association between elevated levels of circulating homocysteine and various vascular and cardiovascular disorders. In addition, tHcy levels also are related to birth defects, pregnancy complications, psychiatric disorders,and mental impairment in the elderly. Clinically the measurement of tHcy is considered important (1) to diagnose homocystinuria, (2) to identify individuals with or at a risk of developing 

Although numerous studies have demonstrated a causal relationship between tHcy and CVD, there is still controversy about the clinical significance of this relationship as (1) the MTHFR 677C—polymorphism is a strong risk factor for increased tHcy but not for CVD (2) there is an apparent discrepancy between prospective and retrospective case-control studies and (3) there is a lack of data from controlled clinical trials.  

Because of this concern over the clinical significance of the causal relationship between tHcy and Refsum and colleagues developed the following recommendations  

Physiologically, homocysteine exists in reduced, oxidized, and protein-bound forms.Methods for tHcy were first introduced in the midl980s that resolved the problems related to the presence of multiple unstable Hey species in plasma by converting all Hey species into the reduced form, HcyH, which is measured as an indication of tHcy content. Consequently, modern methods require pretreatment of plasma or serum specimens with a reducing agent, such as dithioerythritol, dithiothreitol, mercap-toethanol, tributyl phosphine, and tris(2-carboxyl-ethyl) phosphine that converts all Hey species into the reduced form, HcyH, which is measured as an indication of tHcy content. 

Biosynthesis of cysteine. The sulfur is derived from methionine, and the carbon skeleton and amino group are derived from serine. 

Deficiencies of methionine adenosyltransferase, cystathionine 8-synthase, and cystathionine )/-lyase have been described. The first leads to hypermethioninemia but no other clinical abnormality. The second leads to hypermethioninemia, hyperhomocysteinemia, and homo-cystinuria. The disorder is transmitted as an autosomal recessive trait. Its clinical manifestations may include skeletal abnormalities, mental retardation, ectopia lentis (lens dislocation), malar flush, and susceptibility to arterial and venous thromboembolism. Some patients show reduction in plasma methionine and homocysteine concentrations and in urinary homocysteine excretion after large doses of pyridoxine. Homocystinuria can also result from a deficiency of cobalamin (vitamin B12) or folate metabolism. The third, an autosomal recessive trait, leads to cystathioninuria and no other characteristic clinical abnormality. 

Hereditary sulfite oxidase deficiency can occur alone or with xanthine oxidase deficiency. Both enzymes contain molybdenum (Chapter 27). Patients with sulfite oxidase deficiency exhibit mental retardation, major motor seizures, cerebral atrophy, and lens dislocation. Dietary deficiency of molybdenum (Chapter 37) can cause deficient activity of sulfite and xanthine oxidases. 

Cystinuria is a disorder of renal and gastrointestinal tract amino acid transport that also affects lysine, ornithine, and arginine. The four amino acids share a common transport mechanism (discussed above). Clinically, it presents as urinary stone disease because of the insolubility of cystine. In cystinosis, cystine crystals are deposited in tissues because of a transport defect in ATP-dependent cystine efflux from lysosomes (discussed above). 

Homocysteine is an amino acid not found in proteins. Its metabolism involves two pathways one is 

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Homocysteine arises from dietary methionine. High levels of homocysteiae (hyperhomocysteinemia) are a risk factor for occlusive vascular diseases including atherosclerosis and thrombosis (81—84). In a controlled study, semm folate concentrations of <9.2 nmol/L were linked with elevated levels of plasma homocysteiae. Elevated homocysteine levels have beea associated also with ischemic stroke (9). The mechanism by which high levels of homocysteine produce vascular damage are, as of yet, aot completely uaderstood. lateractioa of homocysteiae with platelets or eadothehal cells has beea proposed as a possible mechanism. Clinically, homocysteine levels can be lowered by administration of vitamin B, vitamin B 2> foHc acid. 

Methylcobalamin is involved in a critically important physiological transformation, namely the methylation of homocysteine (8) to methionine (9) (eq. 2) catalyzed by A/ -methyltetrahydrofolate homocysteine methyltransferase. The reaction sequence involves transfer of a methyl group first from... 

Homocysteine has been identified as an independent risk factor for atherosclerosis (32) and thus metaboHc control over homocysteine levels has major health implications. 

The antiviral activity of (5)-DHPA in vivo was assessed in mice inoculated intranasaHy with vesicular stomatitis vims ( 5)-DHPA significantly increased survival from the infection. (5)-DHPA did not significantly reduce DNA, RNA, or protein synthesis and is not a substrate for adenosine deaminase of either bacterial or mammalian origin. However, (5)-DHPA strongly inhibits deamination of adenosine and ara-A by adenosine deaminase. Its mode of action may be inhibition of Vadenosyl-L-homocysteine hydrolase (61). Inhibition of SAH hydrolase results in the accumulation of SAH, which is a product inhibitor of Vadenosylmethionine-dependent methylation reactions. Such methylations are required for the maturation of vital mRNA, and hence inhibitors of SAH hydrolase may be expected to block vims repHcation by interference with viral mRNA methylation. 

Mechanistic aspects of the action of folate-requiring enzymes involve one-carbon unit transfer at the oxidation level of formaldehyde, formate and methyl (78ACR314, 8OMI2I6OO) and are exemplified in pyrimidine and purine biosynthesis. A more complex mechanism has to be suggested for the methyl transfer from 5-methyl-THF (322) to homocysteine, since this transmethylation reaction is cobalamine-dependent to form methionine in E. coli. 

Certain amino acids and their derivatives, although not found in proteins, nonetheless are biochemically important. A few of the more notable examples are shown in Figure 4.5. y-Aminobutyric acid, or GABA, is produced by the decarboxylation of glutamic acid and is a potent neurotransmitter. Histamine, which is synthesized by decarboxylation of histidine, and serotonin, which is derived from tryptophan, similarly function as neurotransmitters and regulators. /3-Alanine is found in nature in the peptides carnosine and anserine and is a component of pantothenic acid (a vitamin), which is a part of coenzyme A. Epinephrine (also known as adrenaline), derived from tyrosine, is an important hormone. Penicillamine is a constituent of the penicillin antibiotics. Ornithine, betaine, homocysteine, and homoserine are important metabolic intermediates. Citrulline is the immediate precursor of arginine. 

In addition, 1 mg of sterile S-2-hydroxyethyl-DL-homocysteine Is added to the tube and the tube is shaken on a rotary shaker at 280 cycles per minute at 25°C for seven days. 

In addition to the twenty amino acids commonly found in proteins, two others—selenocysteine and pyrrolysine—are found in some organisms, and more than 700 nonprotein amino acids are also found in nature. y-Amino-butyric acid (GABA), for instance, is found in the brain and acts as a neurotransmitter homocysteine is found in blood and is linked to coronary heart disease and thyroxine is found in the thyroid gland, where it acts as a hormone. 

Methyl-tetrahydro folic acid is furthermore, together with vitamin B12 and B6, required to regenerate homocysteine (see Vitamin B12, Fig. 1). Homocysteine results when methionine is used as a substrate for methyl group transfer. During the last few years, homocysteine has been acknowledged as an independent risk factor in atherosclerosis etiology. Folic acid supplementation can help reduce elevated homocysteine plasma levels and is therefore supposed to reduce the risk of atherosclerosis as well [2]. 

N5-Methyltetrahydrofolate homocysteine methyl-transferase (= methionine synthase). This reaction is essential to restore tetrahydrofolate from N5-methyltetrahydrofolate (Fig. 2). 

Relatively few reports have been published subsequently on the use of these reagents. Hope and coworkers99 have used sodium in liquid ammonia to cleave the benzyl sulphonyl derivatives of cysteamine, L-cysteine and L-homocysteine to prepare the corresponding sulphinic acids, as in equation (42). 

CxH Hg02, 62-38-4) see Phenylmcrcuric borate phenylmercuric hydroxide (C H HgO 100-57-2) see Phenylmercuric borate JV-[(phenylmethoxy)carbonylJ-DL-homocysteine acetate (ester)... 

Enzymatic methylation of homocysteine (HSCHjCHjCHNHjCOOH) by methylcobalamin to give methionine (CH3SCH2CH2CHNH2COOH) was discovered in 1962 by Woods and co-workers, who also noticed the occurrence of a much slower, nonenzymatic reaction giving the same products. Methylcobinamide showed the same activity as the cobalamin in both the enzymatic and nonenzymatic reactions (72, 7/). It was subsequently discovered that HS, MeS , PhS , and w-BuS will dealkylate a variety of methyl complexes [DMG, DMG-BF2, DPG, G, salen, (DO)(DOH)pn, cobalamin] and even ethyl-Co(DMG)2 complexes to give the thioethers, and it was suggested that the reaction involved transfer of the carbonium ion to the attacking thiolate 161, 164), e.g.,... 

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